Optimizing oxygen delivery in sepsis: A review

Abstract

Multiple organ failure syndrome (MOFS) is a hallmark of sepsis. The continued dysfunction of microvascular perfusion has been implicated as the inciting factor for this. Multiple etiopathological factors are involved in producing this disequilibrium in the demand, supply, and extraction of oxygen as a result of derecruitment of microcirculation. This is further complicated by mitochondrial dysfunction in the form of the inhibition of mitochondrial respiratory chain of enzymes, leading to difficulty in extraction of the oxygen at the cellular level. Eventually, although hemodynamic stability of systemic/macrovascular circulation may have been achieved, the process of deficient and defective delivery of oxygen to the tissues goes on relentlessly. The indicators and monitoring of this process of impairment of oxygen delivery (DO2) have been discussed in this review. In addition, the review also encompasses various therapeutic modalities and their efficacy, based on the evidence. The latest guidelines regarding optimizing the DO2 in sepsis are also included here.